Surgical Infection Society of Europe Abstracts.

Background The aim of this study was to determine whether the route of administration of nutrients might affect the postoperative complication rate and to calculate costs of the treatments. Methods Two hundred and fifty-seven patients with cancer of stomach (n = 121), pancreas (n = 110) and oesophagus (n = 26), candidates for curative surgery, were randomized into two groups to receive total parenteral nutrition (TPN) (n = 131) or early enteral nutrition (EN) (n = 126) after operation. The full nutritional goal was 25 kcal kg^-1 day^-1. The two regimens were isocaloric and isonitrogenous and were continued until oral intake was 1000 kcal day^-1. In 20 consecutive patients per group intestinal oxygen tension was evaluated by a micropolarographic implantable probe. Complications requiring either reoperation or patient transfer to the intensive care unit were defined as major. Results Groups were homogeneous for baseline and surgical variables. The nutritional goal was reached in 100 (79·4 per cent) of 126 in the EN group and 128 (97·7 per cent) of 131 in the TPN group. Alterations in glucose metabolism (4·7 versus 9·1 per cent; P < 0·05) and of plasma electrolytes (3·9 versus 13·7 per cent; P < 0·05) were significantly lower in the EN group with respect to the TPN group. Intestinal oxygen tension significantly increased in the EN group from day 5 after operation compared with that in the TPN group mean(s.d.) 43(5) versus 31(4) mmHg respectively; P < 0·05). EN was one-quarter the cost of TPN (13·2(2·0) versus 69·4(4·4) euro day^-1). Conclusion Early EN was well tolerated. EN decreased metabolic complications and improved intestinal microperfusion. The route of administration of nutrients does not significantly affect postoperative outcome. EN is considerably less expensive than TPN and therefore represents a suitable alternative to TPN in this type of patient.... [ABSTRACT FROM AUTHOR]